急诊科中与对比剂相关急性肾损伤相关的因素：黎巴嫩的一项队列研究。

Factors associated with contrast-associated acute kidney injury in an emergency department: A cohort study in Lebanon.

作者信息

Al Hariri Moustafa, Al Hassan Sally, Khalifeh Malak, Tamim Hani, El Majzoub Imad, El Zahran Tharwat

机构信息

Tamayuz Simulation Center, QU Health Sector, Qatar University, Doha, Qatar.

Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

出版信息

PLoS One. 2025 Mar 13;20(3):e0316604. doi: 10.1371/journal.pone.0316604. eCollection 2025.

DOI:10.1371/journal.pone.0316604

PMID:40080490

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11906086/

Abstract

BACKGROUND

Contrast-associated acute kidney injury (CA-AKI) is a common problem in hospitals, particularly in low-middle-income countries (LMIC), due to limited resources and a high prevalence of comorbidities. Kidney function evaluation using serum creatinine levels before contrast administration leads to increased length of stay and delayed patient care. This study aimed to identify factors associated with CA-AKI in emergency department (ED) patients in an LMIC. Identifying these factors is essential for enhancing patient care and guiding clinical practice by allowing for the early detection and management of patients at risk.

METHODS

This study is a retrospective cohort study conducted at the largest tertiary care center's ED in Lebanon between November 2018 and December 2019. The study included ED patients who underwent computed-tomography (CT) with contrast. Bivariate and logistic regression analyses were performed to compare the characteristics of patients who developed AKI with those who did not by using SPSS package. The Institutional Review Board (IRB) at the American University of Beirut (AUB) approved this study under protocol ID BIO-2020-0276, which was performed per the Declaration of Helsinki. The IRB waived the need to consent patients since many of them were not followed up at the time of the study.

RESULTS

The study included 1832 patients, of whom 10.4% (n = 190) developed CA-AKI. Patients aged over 65 had a 1.6-fold higher risk of CA-AKI (aOR = 1.55, 95%CI:1.09-2.2). High blood pressure (≥140 mmHg), high respiratory rate ( ≥ 22), and chronic kidney disease were significantly associated with CA-AKI. The use of loop diuretics (aOR = 2.21, 95%CI:1.49-3.28), beta-lactams (aOR = 4.11, 95%CI:2.63-6.42), and allopurinol (aOR = 2.74, 95%CI:1.43-5.25) were significantly associated with CA-AKI.

CONCLUSIONS

Identifying factors associated with CA-AKI in an emergency setting, such as age, comorbidities, and home medications, can help identify patients at low risk of developing CA-AKI.

摘要

背景

对比剂相关急性肾损伤（CA-AKI）是医院中常见的问题，尤其是在中低收入国家（LMIC），这是由于资源有限和合并症患病率高所致。在使用对比剂之前通过血清肌酐水平评估肾功能会导致住院时间延长和患者护理延迟。本研究旨在确定中低收入国家急诊科（ED）患者中与CA-AKI相关的因素。识别这些因素对于加强患者护理和通过早期发现及管理有风险的患者来指导临床实践至关重要。

方法

本研究是一项回顾性队列研究，于2018年11月至2019年12月在黎巴嫩最大的三级医疗中心急诊科进行。该研究纳入了接受增强计算机断层扫描（CT）的急诊科患者。使用SPSS软件包进行双变量和逻辑回归分析，以比较发生急性肾损伤（AKI）的患者与未发生AKI的患者的特征。美国贝鲁特美国大学（AUB）的机构审查委员会（IRB）根据协议编号BIO-2020-0276批准了本研究，该研究按照《赫尔辛基宣言》进行。由于许多患者在研究时未接受随访，IRB免除了患者的知情同意。

结果

该研究纳入了1832例患者，其中10.4%（n = 190）发生了CA-AKI。65岁以上的患者发生CA-AKI的风险高1.6倍（校正后比值比[aOR]=1.55，95%置信区间[CI]：1.09-2.2）。高血压（≥140 mmHg）、高呼吸频率（≥22次/分钟）和慢性肾脏病与CA-AKI显著相关。使用袢利尿剂（aOR = 2.21，95%CI：1.49-3.28）、β-内酰胺类药物（aOR = 4.11，95%CI：2.63-6.42）和别嘌醇（aOR = 2.74，95%CI：1.43-5.25）与CA-AKI显著相关。